Medicaid Administrative Claiming (MAC) -
Independent School Districts (ISD)
The school-based Medicaid Administrative Claiming (MAC) program provides Texas school districts, including public charter schools, the opportunity to obtain reimbursement for certain costs related to health administrative activities that support the Medicaid program. In order for the cost to be allowable and reimbursable under Medicaid, the activities must be found to be necessary for the proper and efficient administration under the Texas Medicaid State Plan, and must adhere to applicable requirements as defined in State and Federal law.
School districts can be reimbursed for certain medical and health-related activities such as outreach services delivered to students within the district, regardless of whether the student is Medicaid eligible or not, and without any impact on other similar services the student may receive outside the district. Outreach services may be provided to a student or their family and may include activities such as coordinating, referring, or assisting the student/family in accessing needed medical/health or mental care services.
Revenue generated from MAC claims is dedicated to the provision of health services and may be used to enhance, improve and/or expand the level and quality of health/medical services provided to all students within the district.
- What is Medicaid Administrative Claiming for ISD's? (.pdf) (updated 05/27/10)
- Reimbursement Opportunity through MAC (.pdf) 08/14/13)
- Examples of MAC Activities (.pdf) (10/29/12)
- Advance Payment Notification
- MAC & SHARS Participation Report (.pdf) updated 01/13/14
- HHSC Contractor: Fairbanks, LLC
- Department of State Health Services (DSHS) School Health Program
- Medicaid Administrative Claiming (MAC)
- School Health and Related Services (SHARS)
- Texas Education Agency (TEA) website
MAC staff are available to assist with questions concerning Medicaid Administrative Claiming and use of the online MAC financial reporting system.
Frequently Asked Questions
Read frequently-asked questions (.pdf) - updated 12/19/13
Guides / Manuals
View a list of important notices regarding Medicaid Administrative Claiming for Independent School Districts.
In order to participate in the MAC program, districts must first enter into a MAC contract with the Texas Health & Human Services Commission (HHSC). All participation documents must be approved and a MAC contract must be executed prior to the close of the Random Moment Time Study (RMTS) participant list for the quarter in which the district wishes to claim. The effective date (execution date) of the MAC contract is the date signed by the designated HHSC contact.
In addition to the contracting process, each district must also meet HHSC training requirements and participate in the RMTS. The RMTS includes the certification of the participant list and participation in the time study.
Districts that are interested in participating should consider beginning the process as soon as possible, as it may take a couple of months to complete all paperwork and training requirements.
Listing and links to all forms required for participation in the MAC program by ISD's.
The link below contains information regarding the ISD training information. It is IMPORTANT to carefully read all the information provided so as to fully understand who must attend "initial" training and who is eligible to take "refresher" training.
Contact Rate Analysis MACSend email to Rate Analysis MAC Mailbox
Updated: January 27, 2014